Impact of intravascular ultrasound findings on long-term patency after self-expanding nitinol stent implantation in the iliac artery lesion

Abstract

Although intravascular ultrasound (IVUS) predictors of stent patency for the coronary artery lesion have been established, little is known about IVUS predictors of stent patency for the aorto-iliac artery lesion. We analyzed 154 lesions of 122 patients who underwent stent implantation for iliac artery lesions. Quantitative and qualitative IVUS analyses were performed for pre- and post-procedural IVUS imaging in all lesions. Target lesion revascularization (TLR) was defined as clinically driven revascularization with >50 % angiographic stenosis of the target lesion. The mean follow-up period was 39 ± 16 months. TLRs were performed in 13 lesions (8.4 %). Post-procedural minimum stent area (MSA) was significantly smaller in the TLR group compared to the no-TLR group (16.0 ± 5.8 vs. 25.6 ± 8.5 mm(2), p < 0.001). Stent edge dissection was frequently observed in the TLR group compared to the no-TLR group (53.8 vs. 24.1 %, p = 0.04). Multivariate analysis revealed that post-procedural MSA (OR = 0.76, p < 0.01) and stent edge dissection (OR = 10.4, p < 0.01) were independent IVUS predictors of TLR. Receiver-operating characteristic analysis identified post-procedural MSA <17.8 mm(2) as the optimal cut-point for the prediction of TLR (AUC = 0.846). Post-procedural MSA and stent edge dissection could predict long-term stent patency in the iliac artery lesion. Our results propose that adequate stent enlargement without edge dissection might be important to reduce TLR in the iliac artery lesion.

Thrombotic Lesions are Associated with Poor Outcomes after Endovascular Treatment in Patients with Non-Acute Aortoiliac Total Occlusions

“…Because previous studies have not shown an association between thrombotic lesions and poor dilation before and after stenting can be another cause of restenosis. IVUS analyses, after stent implantation, in the iliac artery lesions showed that the postprocedural minimum stent area might predict longterm stent patency 20) . In our study, the frequency of direct stenting was high, and the frequency of poststenting balloon dilation was low in the thrombotic coronary optical coherence tomography analyses have shown that post-stent, irregular tissue protrusions are associated with subsequent neo-atherosclerosis after stent implantation 19) .…”

Angiographic flow velocity predicts lower limb outcomes after endovascular therapy: Application of the frame count method

“…Recent studies have reported multiple lesion characteristics and insufficient stent enlargement and edge dissection as being associated with unacceptable limb patency. [18][19][20][21] All of these factors can cause low SFA flow velocity, which EVT is supposed to improve. When EVT is performed in patients with PAD, limb patency is affected by the endpoint of EVT.…”

“…18,19 Factors related to EVT characteristics, such as insufficient stent enlargement and edge dissection, have also been reported to affect primary patency. 20,21 However, it is unknown why these factors lead to worse outcomes. We hypothesized that patency failure was ultimately related to lower flow velocity in the affected arteries.…”

Comparison of 3‐year clinical outcomes after endovascular therapy for aortoiliac artery occlusive disease between patients with and without hemodialysis: Subanalysis of the REAL‐AI registry

“…Some studies have reported that female sex, diabetes mellitus, chronic kidney disease, small reference diameter, lesion length, post minimum lumen area, stent edge dissection, lesion calcification, and stent use are independent predictors of restenosis of EVT for the AI artery …”